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Workers' Compensation

How MMI Factors into Your Workers’ Compensation Claim

By April 11, 2022April 25th, 2022No Comments

If you have a workers’ compensation claim in New York, you may be wondering, “What is maximum medical improvement?” Maximum medical improvement (MMI) is a medical and legal determination designating your condition as having improved to the greatest extent possible and no further treatment is currently being recommended to improve it. In practice, a finding of MMI in NY means that there is no surgery pending or expected in the near future. Receiving less radical medical treatments such as PT, chiropractic, or medication does not prevent a finding of MMI.

How MMI is Found

When a finding is made that an injured worker has reached MMI regarding their workers’ compensation claim, the next step is to determine whether or not the injury and resulting inability to work are long-term or permanent.

There are two main types of permanency awards under the NYS Workers’ Compensation Law: Schedule Loss of Use (SLU) awards and Classification. Generally speaking, a SLU award applies when there is an injury to an extremity or a loss of a sense like hearing or vision. A classification applies to injuries involving the neck, back, or head. When an injury involves both, the type of award will depend on the severity of the injuries and work status.

The first step in assessing permanency is to have an evaluation by your doctor to determine the extent of your injuries and whether you have reached “maximum improvement”. The doctor will use the Permanent Impairment Guidelines set forth by the Workers’ Compensation Board, along with physical exam findings, to determine the level of permanency. The insurance carrier will likely have you evaluated by a consultant they hire as well, called an Independent Medical Examiner. If you are considering hiring an attorney to help you through this process, please note that there is very little independence about it. The doctor is selected and paid by the insurance company.

How MMI Affects Compensation

A Schedule Loss of Use award pays a lump-sum benefit depending on the severity of the injury. This award is paid out according to a standardized schedule under the law, where each applicable body part is assigned a certain number of maximum benefit weeks. For example, an arm is worth a maximum of 312 weeks of benefits, a leg is worth a maximum of 288 weeks of benefits, etc. This is the value for a total loss of use of an extremity or an amputation. Most injuries only involve a percentage loss of use of an extremity. For example, if you have lost 10% of the use of your arm, your case is worth 312 x 10% = 31.2 weeks. This is then multiplied by the maximum payment rate in your case. From there, the insurance company will deduct any payments they made to you for lost wage benefits up to that point and your employer may be entitled to reimbursement if you were paid any wages while you were out of work. If there is a balance, you will be owed a lump-sum payment for that amount.

The classification is based on a determination regarding the injured worker’s loss of wage-earning capacity. The Workers’ Compensation Law Judge will factor in both the medical evidence of permanency and any remaining functional capacity, along with testimony on an injured worker’s vocational status. These include age, education, work history, language proficiency, with any other relevant factors. Depending on the date of injury, an injured worker’s loss of wage-earning capacity sets the rate of weekly payments and a cap on the number of weeks of benefits a person can receive.

For injuries after March 13, 2007, an injured worker is only entitled to benefit payments for life if that person has a permanent total disability from all work. Classification awards are only payable if the injured worker is out of work or earning less money than they were at the time of their injury due to their injury.

What To Do Next

A finding of MMI in NY is not legally classified as a settlement. It does not close your case, and you remain entitled to medical benefits. In some cases, you may be entitled to additional maintenance care once there is a finding of MMI.

Maximum medical improvement and permanency is a complicated area of the Workers’ Compensation Law that often involves litigation. To make sure you receive all of the benefits you are entitled to, consult with one of our attorneys today. For a free consultation, call Lewis & Lewis, P.C. at 716-854-2100.

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